Percutaneous Balloon Angioplasty With Adjunctive Stent Placement in the Mesenteric Vessels in a Patient With Takayasu’s Arteritis
1996; Lippincott Williams & Wilkins; Volume: 93; Issue: 10 Linguagem: Inglês
10.1161/01.cir.93.10.1940
ISSN1524-4539
AutoresErol Ozdil, Zvonimir Krajcer, Paolo Angelini,
Tópico(s)Coronary Artery Anomalies
ResumoHomeCirculationVol. 93, No. 10Percutaneous Balloon Angioplasty With Adjunctive Stent Placement in the Mesenteric Vessels in a Patient With Takayasu's Arteritis Free AccessResearch ArticleDownload EPUBAboutView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticleDownload EPUBPercutaneous Balloon Angioplasty With Adjunctive Stent Placement in the Mesenteric Vessels in a Patient With Takayasu's Arteritis Erol Ozdil, Zvonimir Krajcer and Paolo Angelini Erol OzdilErol Ozdil From the Department of Adult Cardiology, Texas Heart Institute at St Luke's Episcopal Hospital, Houston, Tex. , Zvonimir KrajcerZvonimir Krajcer From the Department of Adult Cardiology, Texas Heart Institute at St Luke's Episcopal Hospital, Houston, Tex. and Paolo AngeliniPaolo Angelini From the Department of Adult Cardiology, Texas Heart Institute at St Luke's Episcopal Hospital, Houston, Tex. Originally published15 May 1996https://doi.org/10.1161/01.CIR.93.10.1940Circulation. 1996;93:1940–1941A 49-year-old woman from Italy with a history of Takayasu's arteritis presented with worsening hypertension and symptoms consistent with mesenteric ischemia. The patient had previously undergone aortobifemoral bypass for Leriche's syndrome and peripheral angioplasty of the right subclavian artery. At the present hospital admission, peripheral angiography revealed multiple arterial stenoses: 90% stenosis in the left renal artery, 80% in the right renal artery, 90% in the celiac trunk (Fig 1A), and 99% in the superior mesenteric artery (Fig 2A and B). Pressure gradients were 130 mm Hg across the celiac ostium, 145 mm Hg across the superior mesenteric ostium, 135 mm Hg across the right renal artery, and 45 mm Hg across the left renal artery. The patient underwent percutaneous balloon angioplasty, with excellent results in the renal arteries. The mesenteric vessels, however, did not respond adequately to angioplasty because of persistent elastic recoil, despite prolonged inflation of the balloon. Therefore, an 8×40-mm balloon was used to place a Palmaz P204 (Johnson & Johnson) intraluminal stent in the ostium of the superior mesenteric artery (Fig 2C and 2D). Similarly, an 8×30-mm balloon was used to place a Palmaz P154 stent in the ostium of the celiac trunk (Fig 1B). No residual stenosis or pressure gradient was noted after stent placement. The patient tolerated the procedure well and was discharged. At 8-month follow-up, the patient reported no abdominal pain and had no hypertension on medical therapy.Dense fibrotic lesions are often present during the late occlusive phase of Takayasu's arteritis. High inflation pressures may be required to dilate these lesions, which are associated with significant elastic recoil, especially in the ostial locations. Stents may be beneficial in treating lesions in which persistent elastic recoil prevents adequate results with balloon angioplasty. Reprint requests to Paolo Angelini, MD, PO Box 20206, Houston, TX 77225.The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke's Episcopal Hospital and Texas Heart Institute, 6720 Bertner, MC 4-265, Houston, TX 77030.Download figureDownload PowerPoint Figure 1. Selective injection in the anteroposterior view (A) demonstrating a critical lesion in the ostium of the celiac artery. B (anteroposterior view) demonstrates successful percutaneous transluminal angioplasty and adjunctive placement of a Palmaz stent in the ostium of the celiac artery.Download figureDownload PowerPoint Figure 2. Selective injection in the anteroposterior view (A) and lateral view (B) demonstrating a critical lesion in the ostium of the superior mesenteric artery (sma). C (anteroposterior view) and D (lateral view) demonstrate successful percutaneous transluminal angioplasty and adjunctive placement of a Palmaz stent in the ostium of the superior mesenteric artery; no residual lesion is visible. Previous Back to top Next FiguresReferencesRelatedDetailsCited By Splinter R and Parigger C (2015) Fluid-Dynamic Phenomena in Cardiovascular Ablation with Laser Irradiation Lasers in Cardiovascular Interventions, 10.1007/978-1-4471-5220-0_2, (15-30), . Marzelle J, Desgranges P, Kobeiter H, Cochennec F, Mayer J and Becquemin J (2012) Traitement endovasculaire des lésions des artères digestives, EMC - Techniques chirurgicales - Chirurgie vasculaire, 10.1016/S0246-0459(12)56564-0, 7:2, (1-11), Online publication date: 1-May-2012. Drelich-Zbroja A, Jargiello T, Szymanska A, Krzyzanowski W, ElFurah M and Szczerbo-Trojanowska M (2003) The diagnostic value of levovist in Doppler imaging of visceral arteries in patients with abdominal angina before and after angioplasty, European Journal of Ultrasound, 10.1016/S0929-8266(02)00077-0, 16:3, (225-235), Online publication date: 1-Feb-2003. Mendes W, Espinosa G and Abreu J (2003) Angioplastia com implante de "stent" na artéria mesentérica superior, Revista do Colégio Brasileiro de Cirurgiões, 10.1590/S0100-69912003000100013, 30:1, (76-78), Online publication date: 1-Feb-2003. Luther B (2001) Sonderformen Intestinale Durchblutungsstörungen, 10.1007/978-3-642-57620-1_4, (149-197), . 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